The Department of Health and Social Care (DHSC) (2024) has launched a 12-week public consultation, which began on 26 November 2024, to explore proposals aimed at enhancing accountability and professionalism among NHS managers in England, while bolstering whistleblower protections. This consultation seeks to address gaps in the current regulatory landscape and to ensure that NHS leadership fosters a culture of transparency, patient safety and trust.
This move has been a long time coming. The proposal for a regulatory framework for NHS managers has been prompted by long-standing concerns over leadership accountability, patient safety and whistleblower protection. The proposals present both potential benefits and challenges.
Key proposals under review include the introduction of a voluntary accreditation register, statutory barring mechanisms and full statutory registration for NHS managers, with the aim of holding managers accountable for their actions.
The proposed regulatory framework is intended to apply, at a minimum, to board-level directors within NHS organisations, directors in arm's length bodies and members of integrated care boards. This targeted approach aims to strengthen governance and to ensure high standards of leadership at critical levels of decision-making. However, the consultation also invites views on whether the framework should be extended to other managerial roles within the NHS to promote more comprehensive accountability.
To support these regulatory changes, the DHSC is concurrently developing a single code of practice alongside robust standards and competencies for NHS leaders and managers. This code will serve as a benchmark for professional behaviour, outlining clear expectations for leadership, ethical practice and adherence to patient-centred values. The alignment of these standards with the regulatory framework is intended to provide clarity, consistency and a shared vision for NHS leadership.
Responses to the consultation will have a critical role to play in shaping the final regulatory approach, with an emphasis on building a healthcare system where patients and staff feel respected and supported. All stakeholders, including nurses, are encouraged to participate in the consultation to help shape the future of NHS leadership and accountability.
Explicitly barring managers who retaliate against whistleblowers could encourage reporting of negligence, encouraging a safer and more supportive environment for staff.
Statutory registration or accreditation bring NHS management in line with other regulated professions, such as nurses, doctors and allied health professionals. This could enhance the reputation of managerial roles and attract high-quality individuals to NHS leadership positions.
However, there are going to be challenges associated with implementing and maintaining a regulatory framework. There is likely to be an immense bureaucratic burden involved in the registration systems and oversight bodies. Such an initiative could divert funds and attention from frontline healthcare services.
A heavily regulated environment could discourage talented individuals from pursuing managerial roles. Despite good intentions, rigid enforcement could lead to tokenistic, tick-box adherence as opposed to genuine cultural change. Managers might avoid taking decisive action in fear of potential accusations. And resistance to change could hinder the successful implementation of the framework. From a legal perspective, introducing statutory barring mechanisms and professional duties could create legal challenges, particularly concerning employment rights, delaying reforms and resulting in additional costs for the NHS.
Consulting stakeholders and piloting aspects of the framework could help address potential obstacles and ensure a fair approach.
The DHSC is responding to public, political and professional demands for a system where NHS managers are to be held to the same high standards as clinicians, ultimately aiming to improve governance, transparency and patient outcomes.